Provider Demographics
NPI:1952624165
Name:SISWICK, HEATHER ANN (MA)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:ANN
Last Name:SISWICK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 MILL STREET
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085
Mailing Address - Country:US
Mailing Address - Phone:413-568-6141
Mailing Address - Fax:413-572-4144
Practice Address - Street 1:77 MILL STREET
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085
Practice Address - Country:US
Practice Address - Phone:413-568-6141
Practice Address - Fax:413-572-4144
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1300881Medicaid